Pharmacist Services Jon C. Schommer and Anthony W. Olson www.mdpi.com/journal/pharmacy Edited by Printed Edition of the Special Issue Published in Pharmacy Pharmacist Services Pharmacist Services Special Issue Editors Jon C. Schommer Anthony W. Olson MDPI • Basel • Beijing • Wuhan • Barcelona • Belgrade Special Issue Editors Jon C. Schommer University of Minnesota USA Anthony W. Olson University of Minnesota USA Editorial Office MDPI St. Alban-Anlage 66 4052 Basel, Switzerland This is a reprint of articles from the Special Issue published online in the open access journal Pharmacy (ISSN 2226-4787) from 2018 to 2019 (available at: https://www.mdpi.com/journal/pharmacy/ special issues/Pharmacist Services). For citation purposes, cite each article independently as indicated on the article page online and as indicated below: LastName, A.A.; LastName, B.B.; LastName, C.C. Article Title. Journal Name Year , Article Number , Page Range. ISBN 978-3-03921-754-0 (Pbk) ISBN 978-3-03921-755-7 (PDF) c © 2019 by the authors. Articles in this book are Open Access and distributed under the Creative Commons Attribution (CC BY) license, which allows users to download, copy and build upon published articles, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. The book as a whole is distributed by MDPI under the terms and conditions of the Creative Commons license CC BY-NC-ND. Contents About the Special Issue Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Preface to “Pharmacist Services” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Jon C. Schommer and Anthony W. Olson Pharmacist Services Reprinted from: Pharmacy 2019 , 7 , 141, doi:10.3390/pharmacy7040141 . . . . . . . . . . . . . . . . 1 Benjamin Y. Urick and Emily V. Meggs Towards a Greater Professional Standing: Evolution of Pharmacy Practice and Education, 1920–2020 Reprinted from: Pharmacy 2019 , 7 , 98, doi:10.3390/pharmacy7030098 . . . . . . . . . . . . . . . . 3 Manuel J. Carvajal, Ioana Popovici and Patrick C. Hardigan Gender and Age Variations in Pharmacists’ Job Satisfaction in the United States Reprinted from: Pharmacy 2019 , 7 , 46, doi:10.3390/pharmacy7020046 . . . . . . . . . . . . . . . . 14 Brittany Hoffmann-Eubanks, Anne Marie Kondic and Brian J. Isetts Alignment of Community Pharmacy Foundation Grant Funding and the Evolution of Pharmacy Practice in the United States of America Reprinted from: Pharmacy 2019 , 7 , 63, doi:10.3390/pharmacy7020063 . . . . . . . . . . . . . . . . 26 Jean-Venable Goode, James Owen, Alexis Page and Sharon Gatewood Community-Based Pharmacy Practice Innovation and the Role of the Community-Based Pharmacist Practitioner in the United States Reprinted from: Pharmacy 2019 , 7 , 106, doi:10.3390/pharmacy7030106 . . . . . . . . . . . . . . . . 38 David A. Holdford Using Service Blueprints to Visualize Pharmacy Innovations Reprinted from: Pharmacy 2019 , 7 , 43, doi:10.3390/pharmacy7020043 . . . . . . . . . . . . . . . . 55 Shane P. Desselle, Leticia R. Moczygemba, Antoinette B. Coe, Karl Hess and David P. Zgarrick Applying Contemporary Management Principles to Implementing and Evaluating Value-Added Pharmacist Services Reprinted from: Pharmacy 2019 , 7 , 99, doi:10.3390/pharmacy7030099 . . . . . . . . . . . . . . . . 63 Katherine Knapp, Keith Yoshizuka, Debra Sasaki-Hill and Rory Caygill-Walsh Co-located Retail Clinics and Pharmacies: An Opportunity to Provide More Primary Care Reprinted from: Pharmacy 2019 , 7 , 74, doi:10.3390/pharmacy7030074 . . . . . . . . . . . . . . . . 79 Vasudha Gupta and Evan Williams Establishing a New Ambulatory Care Practice Site as a Pharmacy Practice Faculty Reprinted from: Pharmacy 2018 , 6 , 111, doi:10.3390/pharmacy6040111 . . . . . . . . . . . . . . . . 89 Joel F. Farley, Arun Kumar and Benjamin Y. Urick Measuring Adherence: A Proof of Concept Study for Multiple Medications for Chronic Conditions in Alternative Payment Models Reprinted from: Pharmacy 2019 , 7 , 81, doi:10.3390/pharmacy7030081 . . . . . . . . . . . . . . . . 98 v Jacob J. Drettwan and Andrea L. Kjos An Ethical Analysis of Pharmacy Benefit Manager (PBM) Practices Reprinted from: Pharmacy 2019 , 7 , 65, doi:10.3390/pharmacy7020065 . . . . . . . . . . . . . . . . 109 Olufunmilola Abraham and Ashley Morris Opportunities for Outpatient Pharmacy Services for Patients with Cystic Fibrosis: Perceptions of Healthcare Team Members Reprinted from: Pharmacy 2019 , 7 , 34, doi:10.3390/pharmacy7020034 . . . . . . . . . . . . . . . . 122 Laila Safitrih, Dyah A. Perwitasari, Nelci Ndoen and Keri L. Dandan Health Workers’ Perceptions and Expectations of the Role of the Pharmacist in Emergency Units: A Qualitative Study in Kupang, Indonesia Reprinted from: Pharmacy 2019 , 7 , 31, doi:10.3390/pharmacy7010031 . . . . . . . . . . . . . . . . 138 William R. Doucette Innovative Collaboration between a Medical Clinic and a Community Pharmacy: A Case Report Reprinted from: Pharmacy 2019 , 7 , 62, doi:10.3390/pharmacy7020062 . . . . . . . . . . . . . . . . 148 Linda Awdishu, Teri Moore, Michelle Morrison, Christy Turner and Danuta Trzebinska A Primer on Quality Assurance and Performance Improvement for Interprofessional Chronic Kidney Disease Care: A Path to Joint Commission Certification Reprinted from: Pharmacy 2019 , 7 , 83, doi:10.3390/pharmacy7030083 . . . . . . . . . . . . . . . . 155 Frank J. Ascione Preparing Pharmacists for Collaborative/Integrated Health Settings Reprinted from: Pharmacy 2019 , 7 , 47, doi:10.3390/pharmacy7020047 . . . . . . . . . . . . . . . . 173 Linda Awdishu, Renu F. Singh, Ila Saunders, Felix K. Yam, Jan D. Hirsch, Sarah Lorentz, Rabia S. Atayee, Joseph D. Ma, Shirley M. Tsunoda, Jennifer Namba, Christina L. Mnatzaganian, Nathan A. Painter, Jonathan H. Watanabe, Kelly C. Lee, Charles D. Daniels and Candis M. Morello Advancing Pharmacist Collaborative Care within Academic Health Systems Reprinted from: Pharmacy 2019 , 7 , 142, doi:10.3390/pharmacy7040142 . . . . . . . . . . . . . . . . 181 Norman E. Fenn III, Natalie R. Gadbois, Gwen J. Seamon, Shannon L. Castek and Kimberly S. Plake Development of a Unique Student Pharmacist Internship in a Primary Care Provider System Reprinted from: Pharmacy 2019 , 7 , 36, doi:10.3390/pharmacy7020036 . . . . . . . . . . . . . . . . 195 Nathaniel Rickles, Albert Wertheimer and Yifan Huang Training Community Pharmacy Staff How to Help Manage Urgent Mental Health Crises Reprinted from: Pharmacy 2019 , 7 , 133, doi:10.3390/pharmacy7030133 . . . . . . . . . . . . . . . . 201 Sherilyn K.D. Houle, Kristina Kozlovsky, Heidi V.J. Fernandes and Zahava Rosenberg-Yunger Uptake of Travel Health Services by Community Pharmacies and Patients Following Pharmacist Immunization Scope Expansion in Ontario, Canada Reprinted from: Pharmacy 2019 , 7 , 35, doi:10.3390/pharmacy7020035 . . . . . . . . . . . . . . . . 211 Tanvee Thakur, Meredith Frey and Betty Chewning Pharmacist Services in the Opioid Crisis: Current Practices and Scope in the United States Reprinted from: Pharmacy 2019 , 7 , 60, doi:10.3390/pharmacy7020060 . . . . . . . . . . . . . . . . 234 vi James H. Ford II, Aaron Gilson and David A. Mott Systematic Analysis of the Service Process and the Legislative and Regulatory Environment for a Pharmacist-Provided Naltrexone Injection Service in Wisconsin Reprinted from: Pharmacy 2019 , 7 , 59, doi:10.3390/pharmacy7020059 . . . . . . . . . . . . . . . . 243 Ahmad Shakeri, Lisa Dolovich, Lori MacCallum, John-Michael Gamble, Limei Zhou and Suzanne M. Cadarette Impact of the 2016 Policy Change on the Delivery of MedsCheck Services in Ontario: An Interrupted Time-Series Analysis Reprinted from: Pharmacy 2019 , 7 , 115, doi:10.3390/pharmacy7030115 . . . . . . . . . . . . . . . . 262 Karen A. Maes, Jasmine A. Ruppanner, Tamara L. Imfeld-Isenegger, Kurt E. Hersberger, Markus L. Lampert and Fabienne Boeni Dispensing of Prescribed Medicines in Swiss Community Pharmacies-Observed Counselling Activities Reprinted from: Pharmacy 2019 , 7 , 1, doi:10.3390/pharmacy7010001 . . . . . . . . . . . . . . . . . 276 Susanne Kaae, Lotte Stig Nørgaard, Sofia K ̈ alvemark Sporrong, Anna Birna Almarsdottir, Mette Kofoed, Rami Faris Daysh and Nima Jowkar Patients’, Pharmacy Staff Members’, and Pharmacy Researchers’ Perceptions of Central Elements in Prescription Encounters at the Pharmacy Counter Reprinted from: Pharmacy 2019 , 7 , 84, doi:10.3390/pharmacy7030084 . . . . . . . . . . . . . . . . 292 Joseph A. Woelfel, Edward L. Rogan, Rajul A. Patel, Winnie Ho, Hong Van Nguyen, Emily Highsmith, Claire Chang, Nhat-Thanh Nguyen, Morgan Sato and Daniel Nguyen Administration, Billing, and Payment for Pharmacy Student-Based Immunizations to Medicare Beneficiaries at Mobile Medicare Clinics Reprinted from: Pharmacy 2019 , 7 , 22, doi:10.3390/pharmacy7010022 . . . . . . . . . . . . . . . . 304 William R. Doucette, Kelly Kent, Laura Seegmiller, Randal P. McDonough and William Evans Feasibility of a Coordinated Human Papillomavirus (HPV) Vaccination Program between a Medical Clinic and a Community Pharmacy Reprinted from: Pharmacy 2019 , 7 , 91, doi:10.3390/pharmacy7030091 . . . . . . . . . . . . . . . . 311 Roxane L. Took, Yifei Liu and Peggy G. Kuehl A Study to Identify Medication-Related Problems and Associated Cost Avoidance by Community Pharmacists during a Comprehensive Medication Review in Patients One Week Post Hospitalization Reprinted from: Pharmacy 2019 , 7 , 51, doi:10.3390/pharmacy7020051 . . . . . . . . . . . . . . . . 317 Geoffrey Twigg, Tosin David and Joshua Taylor An Improved Comprehensive Medication Review Process to Assess Healthcare Outcomes in a Rural Independent Community Pharmacy Reprinted from: Pharmacy 2019 , 7 , 66, doi:10.3390/pharmacy7020066 . . . . . . . . . . . . . . . . 326 Carina de Morais Neves, Mariana Martins Gonzaga do Nascimento, Daniela ́ Alvares Machado Silva and Djenane Ramalho-de-Oliveira Clinical Results of Comprehensive Medication Management Services in Primary Care in Belo Horizonte Reprinted from: Pharmacy 2019 , 7 , 58, doi:10.3390/pharmacy7020058 . . . . . . . . . . . . . . . . 336 vii Shaquib Al Hasan, Jagannath Mohan Muzumdar, Rajesh Nayak and Wenchen Kenneth Wu Using the Theory of Planned Behavior to Understand Factors Influencing South Asian Consumers’ Intention to Seek Pharmacist-Provided Medication Therapy Management Services Reprinted from: Pharmacy 2019 , 7 , 88, doi:10.3390/pharmacy7030088 . . . . . . . . . . . . . . . . 346 Stephanie Redmond, Nicole Paterson, Sarah J. Shoemaker-Hunt and Djenane Ramalho-de-Oliveira Development, Testing and Results of a Patient Medication Experience Documentation Tool for Use in Comprehensive Medication Management Services Reprinted from: Pharmacy 2019 , 7 , 71, doi:10.3390/pharmacy7020071 . . . . . . . . . . . . . . . . 364 Anne Schullo-Feulner, Lisa Krohn and Alison Knutson Reducing Medication Therapy Problems in the Transition from Hospital to Home: A Pre- & Post-Discharge Pharmacist Collaboration Reprinted from: Pharmacy 2019 , 7 , 86, doi:10.3390/pharmacy7030086 . . . . . . . . . . . . . . . . 380 Yifei Liu, Kendall D. Guthrie, Justin R. May and Kristen L. DiDonato Community Pharmacist-Provided Wellness and Monitoring Services in an Employee Wellness Program: A Four-Year Summary Reprinted from: Pharmacy 2019 , 7 , 80, doi:10.3390/pharmacy7030080 . . . . . . . . . . . . . . . . 388 Theresa J. Schindel, Rene R. Breault and Christine A. Hughes “It Made a Difference to Me”: A Comparative Case Study of Community Pharmacists’ Care Planning Services in Primary Health Care Reprinted from: Pharmacy 2019 , 7 , 90, doi:10.3390/pharmacy7030090 . . . . . . . . . . . . . . . . 400 viii About the Special Issue Editors Jon C. Schommer , R.Ph., PhD, is Professor at the University of Minnesota. He received his BS, MS, and PhD degrees from the University of Wisconsin–Madison. Since graduating with his PhD in 1992, he has devoted his career to teaching and research. His research is focused on information processing and decision making related to the provision, use, and evaluation of drug products and pharmacist services. He recently completed the National Consumer Survey on the Medication Experience—a study of over 36,000 individuals. Dr. Schommer has served as Peters Chair for Pharmacy Practice Innovation, President for the Academy of Pharmaceutical Research and Science, and Member of the American Pharmacists Association Board of Trustees. He holds a Distinguished Teaching Professor appointment and was inducted into the Academy of Distinguished Teachers at the University of Minnesota. In March 2019, he received the Academy of Pharmaceutical Research and Science Research Achievement Award. https://www.pharmacy.umn.edu/bio/cop-experts/jon-schommer. Anthony W. Olson , M.Ed., Pharm.D., PhD candidate, is a graduate student at the University of Minnesota. He received his BA degree from St. Olaf College in Northfield, MN and his M.Ed. from George Mason University in Fairfax, VA. Anthony graduated with a Pharm.D. from the University of Minnesota College of Pharmacy in 2015 and entered the Social & Administrative PhD program shortly thereafter. His expected graduation date is in the spring of 2020, where after he will pursue a career in academic pharmacy. His research has focused on the theory and application of patient-centered care approaches as it relates to pharmacist practice and patient care services. The work is grounded in patient-centered care principles; health behavior theories; decision-making theories; and cognitive, social, and behavioral psychology. Dr. Olson has served as Speaker of the House for the Minnesota Pharmacists Association (MPhA) and Postgraduate Officer for the American Pharmacist Association. He has received the United States Public Health Service Excellence in Public Health Pharmacy Practice Award from the U.S. Deputy Surgeon General, Lilly Achievement Award, and Albert Wertheimer Leadership Fellowship. In October 2019, Dr. Olson was recognized as MPhA’s Distinguished Young Pharmacist. https://www.pharmacy.umn.edu/bio/social-and-administrative-phar/anthony-olson. ix Preface to “Pharmacist Services” Welcome to the Special Issue “Pharmacist Services” of Pharmacy—an open access journal with a focus on pharmacy education and practice. Articles in this Special Issue reveal how pharmacist services can progress in (1) societal relevance, (2) innovative delivery, (3) integration into broader systems, (4) enhanced image to both payers and consumers, and (5) growth into new roles and markets. The articles reveal the overwhelming opportunities that pharmacists can embrace and fill, such as (1) medication optimization, (2) wellness and prevention, (3) chronic care management, (4) acute care management, (5) patient education, (6) care transitions, (7) population health, (8) emergency preparedness, (9) health informatics, and (10) patient-centered, living-in-place care. We trust that you will find the articles in this Special Issue not only informative, but inspiring as well. We greatly appreciate the colleagues who worked to meet a short deadline and were willing to share their work with us. We also wish to thank the editorial staff who coordinated the review and publishing processes. Their professionalism is highly valued. Finally, we wish to thank you, the reader. Please apply the ideas in these articles to your work. Expand upon them. Challenge them. And, then, share your work with us. Jon C. Schommer, Anthony W. Olson Special Issue Editors xi pharmacy Editorial Pharmacist Services Jon C. Schommer 1, * and Anthony W. Olson 2, * 1 College of Pharmacy, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA 2 College of Pharmacy, University of Minnesota-Duluth, Duluth, MN 55812, USA * Correspondence: schom010@umn.edu (J.C.S.); olso2001@umn.edu (A.W.O.) Received: 29 September 2019; Accepted: 1 October 2019; Published: 10 October 2019 Welcome to the “Pharmacist Services” special issue in the journal Pharmacy, an open access journal with a focus on pharmacy education and practice. In 2018, an invitation was dispersed to scholars in the pharmacist services domain asking them to submit a manuscript to this special issue no later than 31 July 2019. We invited these colleagues to think about a full breadth of topics including, but not limited to: (1) The history and development of pharmacist services, (2) service settings, (3) service management, (4) service profitability, (5) service recovery, (6) service relationships, (7) service quality, (8) service tailoring, (9), service design and standards, (10) service performance, and (11) service evaluation. We sought manuscripts of all types including: (1) reviews, (2) commentaries, (3) idea papers, (4) case studies, (5) demonstration studies, and (6) research studies. The call for papers was delineated using ideas published by renowned experts in the services management and marketing domains including: Teresa Swartz, Dawn Iacobucci, Roland Rust, Richard Oliver, Valerie Zeithaml, and Mary Jo Bitner. With this foundational context described and the invitations sent, we waited to learn about what would be submitted in a timeframe of just several months. We are pleased to report that over 30 articles have been published in this special issue and represent the work of about 100 scholars in this domain. To receive such a response from busy colleagues in such a short time-frame is incredible. The overall goal of this special issue on “Pharmacist Services” is to give the reader a state-of-the-art synopsis of the pharmacist services domain in the year 2019. To accomplish this goal, we sought papers that address the social, psychosocial, political, legal, historic, clinical, and economic factors that are associated with pharmacist services. Papers that translate concepts from other domains into the pharmacist services realm were welcomed. As we review the articles in this special issue, a great deal can be learned about (1) pharmacist professionalism, (2) pharmacist practice, and (3) pharmacist progression. Pharmacist Professionalism The articles reveal that pharmacist services vary by country, design, delivery environment, payment schemes, end-user, requisite training, regulatory standards, and more. As di ff erent as pharmacist services are, they are all linked by the individuals who provide them. Whether dispensing or immunizing, reconciling medication lists or performing medication management, pharmacists use their expertise related to medications to pursue excellent, a ff ordable, and accessible healthcare for a common beneficiary: their patients. Pharmacist professionalism is a driving force for translating pharmacists’ expertise into medication use, for helping people achieve medication experiences that are life enhancing. Pharmacist Practice Another emergent theme for pharmacist services described in this special issue is to view them through the Joint Commission of Pharmacy Practitioners (JCPP) Pharmacist Patient Care Process (PPCP), which was created and is supported by pharmacist organizations representing managed care, education, consultants, in-patient practice, outpatient practice, governmental regulatory bodies, Pharmacy 2019 , 7 , 141; doi:10.3390 / pharmacy7040141 www.mdpi.com / journal / pharmacy 1 Pharmacy 2019 , 7 , 141 and more. This model identifies a consistent process of care in the delivery of patient care services consisting of the following five steps: (1) Collect, (2) Assess, (3) Plan, (4) Implement, and (5) Follow-up: Monitor and Evaluate. The articles in this special issue give readers a state-of-the-art snapshot regarding the diversity of pharmacist services through the prism of the JCPP Pharmacist Patient Care Process. Pharmacist Progression Finally, many articles in this special issue reveal how pharmacist services can progress in (1) societal relevance, (2) innovative delivery, (3) integration into broader systems, (4) enhanced image to both payers and consumers, and (5) growth into new roles and markets. The articles reveal the overwhelming opportunities that pharmacists can embrace and fill such as: (1) Medication optimization, (2) wellness and prevention, (3) chronic care management, (4) acute care management, (5) patient education, (6) care transitions, (7) population health, (8) emergency preparedness, (9) health informatics, and (10) patient-centered, living-in-place care. We trust that you will find the articles in this special issue not only informative, but inspiring as well. We greatly appreciate the colleagues who worked to meet a short deadline and were willing to share their work with us. We also wish to thank the editorial sta ff who coordinated the review and publishing processes. Their professionalism is highly valued. Finally, we wish to thank you, the reader. Please apply the ideas in these articles to your work. Expand upon them. Challenge them. And then, share your work with us. © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http: // creativecommons.org / licenses / by / 4.0 / ). 2 pharmacy Review Towards a Greater Professional Standing: Evolution of Pharmacy Practice and Education, 1920–2020 Benjamin Y. Urick * and Emily V. Meggs Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA * Correspondence: benurick@email.unc.edu Received: 31 May 2019; Accepted: 18 July 2019; Published: 20 July 2019 Abstract: The history of community pharmacy in America since the 1920s is one of slow progress towards greater professional standing through changes in pharmacy education and practice. The history of American community pharmacy in the modern era can be divided into four periods: 1920–1949 (Soda Fountain Era), 1950–1979 (Lick, Stick, Pour and More Era), 1980–2009 (Pharmaceutical Care Era), and 2010–present (Post-Pharmaceutical Care Era). As traditional compounding has waned, leaders within community pharmacy have sought to shift focus from product to patient. Increasing degree requirements and postgraduate training have enhanced pharmacists’ ability to provide patient care services not directly associated with medication dispensing. However, the realities of practice have often fallen short of ideal visions of patient-focused community pharmacy practice. Positive trends in the recognition of the impact of community pharmacists on healthcare value and the need for more optimal medication management suggest that opportunities for community pharmacists to provide patient care may expand through the 21st century. Keywords: history of pharmacy; 20th century history; 21st century history; community pharmacy services; pharmacy education 1. Introduction As long there has been a belief in the medicinal properties of natural substances, there have been people whose duty it was to transform these materia medica into medicines. By the 1800s, however, this traditional role of pharmacy had begun to change. The Industrial Revolution led to mass manufacture of medicinal products which once only the pharmacist could produce. Additionally, new medicines were being discovered which could not be easily derived from traditional materia medica. As traditional compounding began to wane and proprietary products began to replace those which the pharmacist used to make himself, merchandising in pharmacies began to increase. The erosion of traditional roles led to a crisis of professionalism within American community pharmacy, requiring the profession to rethink its role in society. It is with this backdrop that the modern era of community pharmacy in the United States begins. For this narrative review, the history of American community pharmacy in the modern era can be divided into four periods: 1920–1949 (Soda Fountain Era), 1950–1979 (Lick, Stick, Pour and More Era), 1980–2009 (Pharmaceutical Care Era), and 2010–present (Post-Pharmaceutical Care Era). A slow march towards greater patient care and higher professional standing can be observed across each of these periods as the profession of pharmacy has struggled with what defines community pharmacy and how community pharmacy adds value to society. 2. 1920–1949: Soda Fountain Era 2.1. Education By the time the modern era of pharmacy dawned in the 1920s, pharmacy education was rapidly adopting three and four-year degrees as the standard for education [ 1 ]. Old-fashioned short courses, Pharmacy 2019 , 7 , 98; doi:10.3390 / pharmacy7030098 www.mdpi.com / journal / pharmacy 3 Pharmacy 2019 , 7 , 98 designed as supplements to apprenticeship, were falling out of favor and would soon be made obsolete. Pharmacy education in the early part of the 20th century was guided by The Pharmaceutical Syllabus [ 1 ]. This detailed guide to pharmacy education, created by the American Association of Colleges of Pharmacy (AACP), helped to standardize degree programs as training became more formalized. The first major study of pharmacy practice, Basic Material for a Pharmaceutical Curriculum, was published in 1927 [ 2 ]. This study sought to revise the curriculum contained in the Pharmaceutical Syllabus by developing a new curriculum based on the functional needs of the pharmacy profession [ 2 ]. Reflecting the makeup of the profession in the 1920s, the Pharmaceutical Curriculum was focused solely on the needs of pharmacists working in retail settings. The report focused on many areas of study deemed essential to pharmacy practice at the time, including basic sciences of chemistry and physics; medicine-related subjects such as pharmacognosy, botany, pharmacology, physiology, and public health; and practice-related subjects such as small-scale pharmaceutical manufacturing, prescription filling, and retail sales operations. The Pharmaceutical Curriculum did not, however, include any information on diagnosis and treatment of disease. While the authors acknowledged that a pharmacist has a duty to assist their “customers” who have questions on “the cure for an ailment,” they were concerned that too much education would lead to counter-prescribing—dispensing pharmaceuticals to treat a disease without or contrary to a prescription from a physician. Merchandising and commercial aspects of pharmacy practice were only begrudgingly included in the Pharmaceutical Curriculum. It was acknowledged that merchandising and commercial interests were rampant within the community pharmacy practice. However, one goal of creating a standardized curriculum was to raise professional standards and train more professionally-oriented graduates who were better able to engage with other healthcare practitioners [ 1 ]. As such, it was thought that inclusion of merchandising and commercial interests would undermine pharmacy’s professionalism and these aspects of pharmacy practice were excluded from the Pharmaceutical Curriculum. Aided in educational transformation during the Soda Fountain Era was the founding of the Accreditation Council for Pharmaceutical Education (ACPE) in 1932. The ACPE established the first national standards for pharmacy degree program accreditation and, as a result, by 1941, 64 out of 67 colleges of pharmacy had adopted a four-year degree standard. The educational change began in The Pharmaceutical Syllabus was furthered by the Pharmaceutical Survey which was commissioned by the American Council on Education in 1946 [ 3 ]. The Pharmaceutical Survey recognized the growing tension between pharmacists as distributors of mass manufactured products and pharmacists as healthcare professionals. The distribution and merchandising roles were seen as undermining pharmacy’s professionalism. Additionally, the four-year degree was thought to be too short a course of study for the pharmacist to complete a general education as well as a pharmacy education [ 4 ], and did not “confer the status that is desired by pharmacists, particularly those who work in rather intimate professional association with physicians, dentists, and members of other health professions who hold professional doctor’s degrees. [4]” Therefore, to provide a complete education and firm the professional foundation of pharmacy practice, the report recommended the establishment of a six-year Doctor of Pharmacy program to a ff ord “new opportunities for raising the level of preparation for the professional areas of pharmacy [ 5 ].” However, the recommendation to lengthen the curriculum was met with opposition by pharmacy educators, and the majority of pharmacy school deans at the time favored the status quo [ 4 ]. The debate within the American Association of Colleges of Pharmacy about degree standards would result in substantial changes to pharmacy education in the 1950s. 2.2. Practice As compounding waned, pharmacy in the 1920s found itself questioning its own professional standing. This is reflected in practice as well as education. Concurrently, the enactment of national prohibition in 1919 was a boon to pharmacies’ front-end commercial interest in two major ways [ 6 ]. First, the sale and consumption of “medicinal” alcohol was allowed and this created a legal loophole 4 Pharmacy 2019 , 7 , 98 which many pharmacists and physicians exploited. Second, soda fountains became very popular destinations for those seeking alcohol-alternatives. Neither was considered a “professional” activity, but both were surely profitable. Accordingly, traditional prescription compounding and dispensing became a minor part of pharmacy operations in the 1920s and 1930s. Although 75% of prescriptions still required some compounding [ 7 ], less than 1% of pharmacies of pharmacies had more than 50% of their sales from prescription drugs [ 8 ]. Even when drugs were dispensed, ethical standards at the time limited pharmacists’ engagement with patients. For example, the 1922 American Pharmaceutical Association (APhA) Code of Ethics [9] stated that: “[The pharmacist] should never discuss the therapeutic e ff ect of a Physician’s prescription with a patron nor disclose details of composition which the Physician has withheld, suggesting to the patient that such details can be properly discussed with the prescriber only”. In the 1920s, the transition away from compounding and towards premanufactured proprietary products led to a crisis within the community pharmacy—pharmacy’s traditional role was waning, and it was not clear what the role of a pharmacist was, if not, compounding. The answer, in many ways, was to increase front-end commercial interests through expanding soda fountains and other goods for purchase. Prescription dispensing was essential to the identity of the pharmacy, but was de-emphasized as a part of the pharmacy’s business. This would change as advances in pharmaceutical research in the mid-20th century led to an explosion of new prescription drug products. 3. 1950–1979: Lick, Stick, Pour and More Era As the patient care roles of the pharmacist and educational standards increased from the 1950s through the 1970s, the highest professional activity was no longer dispensing, as it was in the 1920s. The provision of patient care services replaced dispensing as the highest professional activity. This created a cultural shift within community pharmacy practice—and gave rise to the tension between dispensing and patient care which persists into the 21st century. Arguments over the degree needed to support this new version of professionalism were heated, and would not be ended until the 1980s. 3.1. Education The recommendations of the Pharmaceutical Survey laid the foundation for changes to pharmacy education throughout the 1950s, 60s, and 70s. Leaders in pharmacy education acknowledged that the four-year degree was insu ffi cient for the level of training needed to become a pharmacist. There was strong resistance, however, to a mandatory professional doctorate as the entry level practice degree. An uneasy compromise was made with the adoption of a five-year degree standard, despite specific recommendations against the degree from the Pharmaceutical Survey. As clinical pharmacy and the desire for higher professional standing began to permeate throughout the profession in the 1960s and early 1970s, the movement towards a degree which provided the appropriate professional foundation for clinical pharmacy accelerated. The first pharmacy program to adopt an all-Doctor of Pharmacy (PharmD) standard was the University of Southern California in 1950 [ 10 ]. Other programs followed USC’s lead, and by the mid-1970s there were 20 PharmD programs. Through its emphasis on clinical education and experience, proponents of the PharmD redefined professionalism as not just an avoidance of merchandising or commercial endeavors, but also de-emphasized medication dispensing as a professional activity befitting a PharmD-trained pharmacist. Indeed, dispensing was called a “temporary obfuscation” of the clinical objective of the profession [ 10 ]. Educational changes associated with the clinical pharmacy movement also re-emphasized the practice component of pharmacy education, reducing educational focus on theory-based training in basic sciences [11]. 5 Pharmacy 2019 , 7 , 98 3.2. Practice By 1950, the percent of prescriptions which were compounded had fallen to 25% [ 7 ]. This percentage would decrease further to less than 5% by 1960 and 1% by 1970 [ 7 ]. Concurrent with decreases in traditional compounded prescriptions was a large increase in the number and diversity of premanufactured drug products. An explosion of newly discovered drugs led to an increase of over 50% in the number of drugs dispensed during the 1950s [ 6 ]. By the mid-1950s, pharmacists were stepping away from soda fountain and were back behind the pharmacy counter. However, the role had changed substantially from the 1920s. Pharmacists were primarily dispensing premanufactured capsules and tablets, and ethical standards at the time still prohibited them from discussing the contents of prescriptions with patients [ 12 ]. Prescription labels from that era commonly omitted the name of the product dispensed—with the idea that labeling the vial with the name of the drug would violate the physician-patient relationship. This was the origin of the modern “lick, stick, and pour” pharmacy practice. This new version of pharmacy irked many patient care-oriented pharmacists at the time because they desired to do more than simply dispense a product. Eugene White, among the more well-known visionaries of what would become patient care-oriented community pharmacy practice, began working in 1950 at a typical retail-oriented pharmacy. He quickly became disillusioned with practice standards at the time, saying, “After five months of selling lawn seed and paint, cutting glass for window frames, and dispensing a few prescription orders in between, I could longer take it . . . [ 13 ]” White purchased his own pharmacy in 1957 and in 1960 completely transformed his pharmacy into what he termed a “pharmaceutical center.” Gone was the soda fountain and self-serve retail space for candy, stationary, billfolds, toys, and gifts. He added a record system to keep track of families’ prescriptions. He hired a receptionist to greet patients when they entered and built a semi-private patient counseling area. His model even served as the basis for professional pharmacies promoted and designed by McKesson in the mid-1960s [14]. Also innovating during this era were pharmacists in community pharmacy practice settings like the Indian Health Service, which in 1966 required private patient counseling areas in all new pharmacies [ 15 ]. The 1960s also witnessed the birth of clinical pharmacy services, with major innovation stemming from experiments including the Ninth Floor Project led by University of California, San Francisco School of Pharmacy faculty [ 16 ]. This project revolutionized the provision of pharmacy services in hospitals by building a satellite pharmacy to dispense unit-dose medications specific to each order and to prepare admixtures by pharmacists instead of nurses, which at the time were radical advancements. In addition, the pharmacist was available for consultation on drug information and other clinical questions as they arose. This experiment spurred the development of similar clinically-focused pharmacy roles nationwide would substantially influence changes in pharmacy practice philosophy in the 1980s. Eugene White and innovators like him replaced customers with patients, and through this they redefined how a professional community pharmacy operated. Combined with the growth in clinical pharmacy in hospitals during this same time, this transformation revolutionized how the profession saw itself. This was change was reflected in the 1969 revision to APhA’s Code of Ethics [ 17 ] which referred to a pharmacist’s duty to his patient in the first section: A pharmacist should hold the health and safety of patients to be of first consideration; he should render to each patient the full measure of his ability as an essential health practitioner. Practice changes continued through the 1970s. Products became more diverse, and spillover from the clinical pharmacy movement began to expand the array of non-dispensing services provided in pharmacies. Additionally, the first computer systems in the 1970s expanded pharmacists’ abilities to keep dispensing records and check for drug–drug interactions [6]. The period from the 1950s to 1970s was a pivotal time for American pharmacy. The emphasis on front-end merchandising and soda fountains waned as dispensing increased. A new version of 6 Pharmacy 2019 , 7 , 98 professionalism had started to arise within community pharmacy—one focused not on dispensing alone but on dispensing as a part of care for a patient’s medication-related needs. Education also witnessed a similar evolution, with new PharmD degree programs supporting the training needed to provide robust patient care services. Ethical standards likewise evolved, with the 1969 APhA Code of Ethics calling for pharmacists to engage in activity that would have been ethically suspect under previous codes. These changes built the foundation for changes in the 1980s that would further propel the notion that community pharmacists had an obligation to their patients which extended beyond simple dispensing of products. 4. 1980–2009: Pharmaceutical Care Era 4.1. Education The final major change to pharmacy education in the last 100 years was the transition from the five-year, entry-level B.S. degree with the optional post-graduate PharmD training to the PharmD becoming the entry level degree. Echoing the Pharmaceutical Survey from nearly 40 years prior, the Final Report of the Task Force on Pharmacy Education, commissioned by the American Pharmaceutical Association (APhA) and released in 1984, called for a universal six-year PharmD degree [ 18 ]. Following this call, the universal PharmD degree was put to a vote in the American Association of College of Pharmacy (AACP) House of Delegates in 1985 but was defeated by a narrow margin. Nevertheless, major national conferences and academic papers throughout the end of the 1980s helped sway opinion towards a universal PharmD and acceptance of pharmacy as a clinical profession which needed a professional doctorate. In 1989, A Declaration of Intent was made by ACPE to adopt the PharmD as the universal standard for pharmacy education as soon as 2000 [ 19 , 20 ]. Through the early 1990s, APhA, the National Association of Retail Druggists, and the American Society of Hospital Pharmacists, the American College of Clinical Pharmacy, the National Association of Boards of Pharmacy, and AACP came to actively support the single degree standard but the organization represent